Syntax Score I and II for Predicting Carotid Artery Stenosis in Patients with Multivessel Coronary Artery Disease: A Propensity Score Matching Analysis

Abstract

Objective To evaluate the predictive accuracy of SYNTAX score (SS) I and II for detecting significant carotid artery stenosis (CAS) in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery. Methods The study population consisted of 416 patients. Clinical, demographic, and radiological records were retrospectively reviewed. Characteristics of patients with CAS (n=66) and patients without CAS (n=350) were compared before and after propensity score matching analysis. Results Patients with significant CAS were older compared to those without significant CAS [(60 (53-65) vs. 63 (59-67); P=0.01]. However, atherosclerotic risk factors and SS I were similar between groups. SS II CABG and percutaneous coronary intervention (PCI) were significantly higher in patients with CAS [37.4 (30.9-43.5) vs. 33.8 (29.9-38.9); P=0.02]. After propensity score matching analysis (66 vs. 66), age, SS II PCI and CABG were significantly higher in patients with CAS than those without CAS [37.4 (30.9-43.5) vs. 33 (29.3-36.9); P=0.03]. Age, SS II PCI and CABG were associated with CAS in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P<0.001; OR=1.054, 95% CI (1.010-1.101), P=0.02; OR=1.078, 95% CI (1.029-1.129), P<0.01]. In ROC curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P<0.01, 95% CI (0.583-0.749)] to predict CAS. Pairwise comparison of ROC curves revealed similar statistical accuracy for prediction of CAS (z statistic: 0.683, P=0.49) Conclusion SS II is useful to predict asymptomatic CAS in patients with multivessel coronary artery disease.